=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831331081
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TACTUS MASSAGE THERAPIES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/02/2009
-----------------------------------------------------
Last Update Date | 04/02/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1828 NW OVERTON ST
-----------------------------------------------------
City | PORTLAND
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97209-1617
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-750-2804
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1828 NW OVERTON ST
-----------------------------------------------------
City | PORTLAND
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97209-1617
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-750-2804
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEDICAL MASSAGE THERAPIST
-----------------------------------------------------
Name | PABLO COHEN
-----------------------------------------------------
Credential | L.M.T
-----------------------------------------------------
Telephone | 503-750-2804
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number | 7863
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------